NOTE: This article was first written in late December, when the cholera epidemic was still a novel threat to Haiti. Please keep in mind that the statistics in this piece are time-sensitive, so they probably have changed. Regardless of the time of this writing, the historical, social, and cultural components that this article discuss are still relevant to the study of disease and it’s contextualization within separate societies.
Haiti was a country untouched by cholera until the current epidemic proliferated throughout its virgin landscape. In being a novel experience, the cholera epidemic does not recall pre-existing myths and beliefs about the infection and allows a unique opportunity to witness how a profile of disease is created by the affected society. The outbreak has demonstrated how both historical events and the current social environment has the ability to shape perceptions of and responses to disease. For example, historical outbreaks in other nations have informed the public health response, yet economic disparities confound attempts to reform health behaviors. The physical environment, scavenged by Hurricane Katrina and the January 2010 earthquake, has placed a fatalistic view upon the incidence of cholera. The existing “disease-environment” characterized by high morbidity and mortality has influenced a loss of trust in the national government. Past experiences with colonial powers and imperialist rule have created an atmosphere of malcontent with foreign forces. Furthermore, the recent election plagued by corruption, fraud, and underrepresentation, in combination with the wrath inflicted by cholera, has exaggerated socio-economic disparities. Although cholera is essentially a biological phenomenon, it is defined by the social underpinnings of the society in which it infects.
For a quick overview, cholera is an acute illness that occurs after infection of the intestine by Vibrio cholerae bacterium. Severe infection can result in profuse watery diarrhea, vomiting, and cramps; a resulting loss of body fluids can lead to dehydration, electrolyte loss, and shock. Left untreated, this infection can kill. About 3 to 5 million people are infected every year and 100,000 die – most of these cases are seen in developing countries where conditions are favorable for infection.
In some respect, Haiti is lucky that there is such a volume of discourse about and experience with cholera in the international sphere; therefore, education campaigns could be created quickly by world health organizations and spread to Haitian communities. As quoted from Hôpital Albert Schweitzer (HAS) – one of the first hospitals to receive cholera patients – “the public information program by the Ministry of Health, the local Rotary clubs, and by the HAS field staff appear to have been effective, as patients come to the hospital early in the course of the disease.”[1] Additional health promotion activities have been provided on the community level, often in the well-established networks of churches, to reinforce these public information campaigns.[2] The measure of this success is demonstrated by the frequent and accurate explanations of cholera from several newspaper outlets and even the young-adult Internet blog, VwaJen.[3] Sadly, though, Haiti is unlucky because the dire straits of poverty and inaccessibility to sanitary water restrict the effective uptake of these messages, as nearly 70% of the population does not have access to potable water.[4] Furthermore, newspapers and blogs are able to demonstrate that they’ve accommodated the messages of sanitation but also explicitly recognize the population does not have the means to make substantial changes, “the living conditions in Haiti are almost medieval. There is no electricity, no drinking water, public transport is in a state of extreme dilapidation, and housing problems have reached the limits of hell, especially in the city of Port-au-Prince.”[5] Whereas the novelty of this disease has allowed the commonplace to accommodate the standardized health messages, it’s inherent poverty and unsanitary conditions confound the potential benefits of this variable.
The physical environment and, more specifically, the occurrence of natural disaster also appeared to have held influence over the general response of the Haitian majority. The chilling memory of the January 12th earthquake, which killed over 230,000 citizens and displaced 1.5 million, is frequently recalled within the Haitian dialogue. The more recent hurricane Tomas also inflicted a great deal of damage upon an already hurting population. A Haitian reporter suggests there is an “inability of the Haitian popular consciousness to understand and explain the phenomenon of the earthquake as being purely natural and not the expression of the will of any spirit of a god or God Almighty who punishes sinners in general.”[6] The repeated occurrences of natural disasters have imposed a fatalistic mood upon the population and called into question their belief of an otherworldly deity. Their dialogue and questions reveal a sense of defeat, doubt, and pessimism; “Haiti still unable to get up, to cope with the unleashing of nature… How is it that a country like Haiti can never get out, rain or shine, and that we have the distinct impression that the country is regressing rather than moving forward?”[7] The population has been primed with a fragile sense of confusion; upon invasion of the cholera bacilli, the stability of the public’s consciousness has fractured. As a result, the response of the population oscillates between anger and despair, resignation and rage, all while trying to place blame and find security. The unprecedented magnitude of the previously discussed reactions, such as malcontent with national governance and violence directed towards international force, has been the direct response of a population primed with fatalistic views and a brittle spirit incurred by repeated natural disasters.
Haiti’s response to the cholera epidemic receives impetus by its previous and ongoing struggle with disease and public health.[8] The concerns of greatest relevance to the locals are that of premature death, malnutrition, and deadly infections diseases, as conveyed through this opinion, “While in this country even thousands of children die at birth and thousands more never reach their fifth birthday; while plagued by hunger and death that follows, before the disastrous earthquake.”[9] Haitians understand that these issues are caused by deficient sanitation systems, poor nutrition, and inadequate health services – their country ranking last in the western hemisphere in care spending. As a result, Haitians interpret their poor disease-environment to be a consequence of national governmental ignorance. They express, “History has bequeathed to Haiti inequality, dictatorship, corruption, and extreme and persistent poverty, which all contribute in their way for the Haitian government’s failure to provide clean water to the population.” The population, therefore, views cholera as another reason to believe in the failure of the government, expecting that the government will maintain status quo and do little to relieve the symptoms of the populace; “The consequence: a vicious cycle of contaminated water consumption, ineffective public hygiene, health crises and recurrent underlying all the foregoing, chronic poverty and deeply rooted (24 Dec, pg 15, HL). “ Upon recognition of a poor disease-environment and understanding it as the fault of governmental disregard, the population responds with a heightened campaign that carries criticisms of current politicians and election candidates. A reporter claims that they, the local citizens, have been ignored by the politicians and are “people trampled by leaders who promote their own well-being,” and later suggests that, “Maybe other more lucrative targets are being pursued by our leaders, and [this ignorance] contributes to the Haitian genocide.[10]” Additionally, a recent anti-imperialism movement, representing large swaths of Haitians, has voiced similar concern. This organization criticizes the corrupt and greedy government of allowing first-world countries to develop neo-colonialist regime within Haiti and to rape it of it’s natural resources, while simultaneously preventing development of important infrastructure that would benefit the indigenous population. Furthermore, this movement threatens the imminent presidential election with boycotts – despite the desperate need for it’s complete representation if the movement’s favored presidential-candidate is to win.
In Haiti, cholera has inflicted pain upon the poor of both the urban slums and the rural hinterlands. As cholera has become understood as a disease of the masses – a disease of the poor, the squalor, and the dirty – the population has come to the recognition that they cannot rely on their national government to provide them with necessary resources. In response, the population has taken up the response to rely on international governmental organizations and aid groups to provide them with the financial and provisional resources to combat this disease.[15] In the blogs released from hospitals within Port-au-Prince, there are constant pleas for assistance, specific requests of supplies, and unceasing thanks for donations already made. A recent blog states, “ it takes about $22 to save the life of a child from cholera… I think you will agree that $22 is not very much money to keep a child alive and give her back to her mother… Let’s splurge. It’s the right thing to do.”[16] It is obvious these pleas for help are not being made to the Haitian population, as $22 is about half of the average Haitian’s monthly salary; instead, such requests reflect a desperate hope that outside donors are their only source of materials. Haiti not only expresses an expectation of individual philanthropy, but also of the supply of medical professionals, whether through non-governmental institutions or informal volunteer networks. They have expected, and since received, a large battalion of Cuban doctors who treat 40% of all cholera cases and “make benefit not only to patients, but also the Haitian medical staff, [the Cuban doctors] having their medical skills at the highest level. They are even helping the campaign of prevention of disease, held in schools by the government and in collaboration with UNICEF.”[17],[18] Ironically – and almost hypocritically – it is this response that delivers Haiti into a perpetual cycle of international reliance, although the population simultaneously demands independence from colonial and neo-colonial bounds.
In his article Cholera and Colonialism, David Arnold presents:
“Like any other disease, [cholera] has in itself no meaning: it is only a micro-organism. It acquires meaning and significance from its human context, from the ways in which it infiltrates the lives of the people, from the reactions it provokes, and from the manner in which it gives expression to cultural and political values.”[19]
In conclusion, the Haitian experience has demonstrated how historical and present-day governmental rule (or lack thereof), combined with inherent poverty, exacerbated with recurrent and abusive natural disasters, and a diversity of other contextual variables has endowed a certain profile upon the cholera bacilli. The responses to this disease have included a failed uptake of educational hygiene messages, not limited by traditional beliefs but by deficient resources; violent episodes between the Haitian majority and UN forces; a continued reliance on international aid; a criticism of nation government; and an unstable, victimized social consciousness.
[1] HAS. “Cholera containment and prevention message getting out.” 27 October 2010.
[2] Some PAHO health bulletin, MAYBE the first
[3] “VwaJen,” (Jen’s Voice) is the first virtual hub in Creole created for the youth of Haiti, developed in close collaboration with the UNICEF Youth Section in New York and the Children’s Radio Foundation, and is meant to transmit the voices of the Haitian youth and provide them with valuable information. The radio pieces, short essays, photos, and videos included on the website were produced over the course of several mini-series hosted by UNICEF, which allowed youth to acquire skills to express opinions and learn about dynamics of policy-making and democratic representation. Starting on Octboer 25th, blogposts have frequently preached the importance of basic hygienic behaviors and of seeking medical treatment. Taken from: http://vwajen.voicesofyouth.org/. Accessed December 12, 2010.
[4] Varma, Monkia Kalra. “Woch nan soley: The denial of the right to water in Haiti.” Health and Human Rights Journal: 10(2):68-89.
[5] Bruzzone, Roberto. “Un bout d’Afrique Noire pauperisee au centre de l”Amerique Latine. Haiti Liberte. November 15, 2010. 7.
[6] Michel, Herve Jean. “Le cholera poursuit ses ravages en Haiti!” Haiti Liberte. December 9, 2010. 14.
[7] Lanctot, Jacques. “Vivement une revolution a Haiti!” Haiti Liberte. 15 November, 2010. 8.
[8] Haiti is a country beset with a host of health related issues: in 2002 it was ranked 101/127 countries based on quality and quantity of potable water, in 2007 it had the lowest life expectancy in the Western Hemisphere, an had appallingly high infant and maternal mortality rates when compared to the rest of Latin America and the Caribbean (57 per 1,000 live births and 630 per 100,000 live births, versus 22.2 per 1,000 live births and 82.8 per 100,000 live births, respectively). The rate of HIV/AIDS incidence, although on the decline, is still the highest in the Latin America with 1.9% of the population having been infected in 2008. Tuberculosis is endemic to the country and is one of the highest causes of death, second behind HIV/AIDS.
Great source which summarizes statistics:
[9] Brazzone, Roberto. “Un bout d”Afrique Noire pauperisee.” 7.
[10] Michel, Herve Jean. “Le cholera poursuit ses ravages en Haiti!” Haiti Liberte. December 9, 2010. 8.
[11] Dupont, Berthony. “L’ieqgalite devant les catastrophes!” 24 November 2010. Haiti Liberte, November 24, 2010, 2.
[12] Mission des Nations Unies pour la Stabilisation en Haiti (MINUSTAH). In June 2004, this mission was authorized after the president of Haiti was exiled as a consequence of several armed conflicts occurring in various cities throughout the country. The original goal was to secure a stable environment, promote clean politics, strengthen governmental institutions, and protect human rights. After the January earthquake, however, MINUSTAH forces and goals were expanded to support quick recovery, reconstruction, and stability efforts. Taken from: “MINUSTAH Background,” United Nations Stabilization Mission in Haiti, lasted modified 2010, http://www.un.org/en/peacekeeping/missions/minustah/background.shtml
[13] A piece published in the New England Journal of Medicine on December 9th by a team of U.S. and Haitian scientists have confirmed that cholera was probably imported by the Nepalese peacekeepers in MINUSTAH. Taken from: Walton, David and Louise Ivers. “Responding to Cholera in Post-Earthquake Haiti,” New England Journal of Medicine, accessed December 11, 2010, http://www.nejm.org/doi/full/10.1056/NEJMp1012997.
[14] Ces événements qui on embrase la cite capoise, prouvent que le people comprend très bien la situation dans laquelle il vit sous ce régime d’occupation impérialiste, ayant reçu la très large bénédiction des laquais du pais.”
[15] In the previous paragraphs about other variables, the inequalities experienced by the cholera epidemic have already shown to implicate a multitude of responses. It has contributed to political discontent, to violent responses against international forces, and has limited the implementation of educational messages. Clearly, the social incidence of cholera does not insinuate one specific response. In this paragraph, I seek to offer a novel response of the population that derives from the unequal incidence of cholera and has not yet been discussed within the framework of previous variables.
[16] Frechette, Rick. “Cholera and Riots.” NPH Saint Damien Hospital Haiti. November 22, 2010. Accessed December 11, 2010. http://saintdamienhospital.nph.org/
[17] Busseien, Tony. “Haiti: jusqu’ou ira l’arrogance des Etats-Unis?” Haiti Liberte. December 8, 2010. 7.
[18] On November 14th, 2010, Cuba provided 800 additional doctors and nurses to Haiti, in addition to the medical forces already present in response to the January 12th earthquake. Taken from: Auken, Bill Van. “Manifestants abattus en Haiti.” Haiti Liberte. November 24, 2010. 8.
[19] Arnold, David. Cholera and Colonialism in British India. Past and Present. 1986; 113(1): 118-151.
This post was written by melissa.frick
